Cost-sharing requirements and access to mental health care among medicare enrollees with schizophrenia

Eric Slade, David S Salkever, Robert Rosenheck, Jeffrey Swanson, Marvin Swartz, David Shern, Gerard Gallucci, Courtenay Harding, Liisa Palmer, Patricia Russo

Research output: Contribution to journalArticle

Abstract

Objective: This study explored the association between Medicare cost-sharing requirements and the probability of use of various mental health outpatient services among Medicare enrollees with schizophrenia. Methods: Multivariate logistic regression was used to estimate the probability of use of each of seven types of services over six months. Patients were recruited from public and private mental health treatment provider organizations in six states. The analyses included 1,088 Medicare enrollees, of whom approximately 55 percent were also enrolled in Medicaid. Results: Medicare-only patients (with greater cost-sharing) were 25 to 45 percent less likely to have used rehabilitation services, individual therapy with nonpsychiatrist mental health providers, and case management. No association was found between Medicaid enrollment and probability of service use for medical clinic visits, group therapy, individual contact with a psychiatrist, or receipt of second-generation antipsychotics. Conclusions: Among Medicare enrollees with schizophrenia, gaps in Medicare coverage may be more problematic for rehabilitation, case management, and contact with nonpsychiatrist providers. Local public and private subsidies for mental health treatment may compensate for some of the gaps in coverage. However, such subsidies are not universally or uniformly provided.

Original languageEnglish (US)
Pages (from-to)960-966
Number of pages7
JournalPsychiatric Services
Volume56
Issue number8
DOIs
StatePublished - Aug 2005

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Cost Sharing
cost sharing
Health Services Accessibility
schizophrenia
Medicare
Schizophrenia
Mental Health
mental health
health care
case management
subsidy
rehabilitation
coverage
Medicaid
Case Management
contact
Ambulatory Care
group therapy
local public
Rehabilitation

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Public Health, Environmental and Occupational Health
  • Health(social science)
  • Health Professions(all)

Cite this

Cost-sharing requirements and access to mental health care among medicare enrollees with schizophrenia. / Slade, Eric; Salkever, David S; Rosenheck, Robert; Swanson, Jeffrey; Swartz, Marvin; Shern, David; Gallucci, Gerard; Harding, Courtenay; Palmer, Liisa; Russo, Patricia.

In: Psychiatric Services, Vol. 56, No. 8, 08.2005, p. 960-966.

Research output: Contribution to journalArticle

Slade, Eric ; Salkever, David S ; Rosenheck, Robert ; Swanson, Jeffrey ; Swartz, Marvin ; Shern, David ; Gallucci, Gerard ; Harding, Courtenay ; Palmer, Liisa ; Russo, Patricia. / Cost-sharing requirements and access to mental health care among medicare enrollees with schizophrenia. In: Psychiatric Services. 2005 ; Vol. 56, No. 8. pp. 960-966.
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